INTEGRATED CHILD DEVELOPMENT SERVICES SCHEME- OBJECTIVES ORGANISATION AND IMPLIMENTATION
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INTEGRATED CHILD DEVELOPMENT SERVICES SCHEME-
OBJECTIVES ORGANISATION AND IMPLIMENTATION - extracted text
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SDA-RF-CH-4.10
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INDIAN JOTJRNAL OF
■PUBTIC HFAIIH
Vol.XXITT,No.3
July- Sent ember, 1979
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imGPAT^D CTin.D mrpjT.cp.TPum STp^TTf,PS SWPW1 _
OB-JTSCTTW!, OPGAmATT^r AMD IMPjW’TATTCTT ’
P-P. Tandon1 and Shakuntala Fnatnagar?'
c,?’ £Z
of
T “h T”r •= “ M“
“
„otle.,s eonrarnl
child »,lfa„ „e Su o? rS’i "’’'Orttaless,
?e dlmensici- The incidence of
morbidity, nortlitv tnd Lit
Various Jirveys £ our^o^S h±°NN
^^imes to be high,
severe malnutrition nmn^rro-ihave indicated th it the incidence of
The iXt^rt't”,".Tv.?ire71h,“J-°r?1’'’r:" ” “
“ 15-20«.
ll.n™ed among oth-k taSL 11"””
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development of the commiidtv.
Vectors and 1>vel of socio-economic
hUtrlMon XSSK.’SSS ‘t°“MhInclrftag
Children the scheme of t CS1N
2nd 7octoS:
-ctor.
I* Tys,wnc J of National Policy for
" °f S°Cial
^og^oS?^
scheine in
1. to improve the nutritional and health
status )f chilc’ren in the a^e
group 0-6 years;
2, to lay the foundations for p------development of the children;poroer nsycholoric; J, Physical and social
3- sch3UNoyNN°iH"M CT
norbidi-,y,
malnutrition and
A- to achieve effectively coordination < " - '
of policy and implementation
ehild d
ongsu the various departments to promote
5 ’ and NSritioN-i
education.
J' '■ ;re 1 opment; and
~
_
the
normal health
after
needs
ch:’ld through nreper nutrition
nee s of ths child
------- .i and health
W °f the moth^ +-°
was decided y°ars°^sid;~£k^
to provide
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-bo ehiJdroiToHS
STlT-U jmrs age group.
' ?~44 y^ars
’
roniowin® essential
expectant .women and wcm6n
and ^pecbant
• 3) Supnnementary nutrition
nJ -immunizationiii) Health cclheck-up
iv) Nutrition .
' ano health education
y) Deferral cservices
vi) Non-formal
— education
On account c" L
*tor
wc4'l^ina+?to-impT’ove
uBi-Lu j b and other Government AgSjs^irJlnlvate:
Hearl ^-p +h
' • 1 r';xesr;or of Medicip.e
Human Nutrition.
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through
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Nenartment cf Gastroenterology &
Medici.
edical Sconces, Ansari Nagar, New Delhi_noni6-
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P cjhrvo'rn- o-d* behioeb 3^w il
development services.. The- anganwadi worker is a female worker recruited
‘ from the village... She is assigned'-the^resnorsibil if j‘“Q5 of., non-formal
r ,'"r edubatipf tq pre sc hootl. children,
ipp'apd ’health
r ' ^dbeatibfP iXrhlie 3 other services of thp
Auxiliary Nurse Nidvdfe
development
of children is inbuilt- In the.-.packagetreafft^ht_'.of-qommop. ailments
r ' during . cho ? d popd s .^Iq-fer. introduced f&r<4vad lafiil'lty. of
rot /.ahgaiiwadi'- T^orkqr 'inrthe village, all the time, o rnlv' '
f-
The . a.dm 1 ni strat.jmit fpjLuthe--^-^atynn^T^~'TrT
was
x e ..
k, sW ru^hp tWfcf';cfcye’l opmnnt
__ci- .chd4e^^?5^a:"
‘Seve 1 opippntj
the urban areEta*7.p^d-"selhL^
projects pTicrity was-’given to a^a^fbad^jw^rd
nutritionally deficient afid' -predomir^nt?^
the1 scheduled
castes and tribes, 'f Initiallythe 33 projects--w-fe nlaced in 1'1 tribal,
1# rural and 4 urban areas. In the years jmp-WO the TOPS scheme has
been expanded to 150 projects “( 56 tribal, "70 rur? 1 and 24 urban) . Pach
project-has apr>roximately foil owing number of beneficiaries per 1000
population.
Children 0-6 y^ars
.
-J g
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170
Pregnant women
30
Lactating women
70
woman of child bearing -
200
age (15.44 vears)
To strengthen the health s.eroHces, ah s dtf it tonal; doctor, 2 ladv
. - health visj.tors and 8 ./VNMs have been sanctioned in these nrojects, so as
to make 1 AW available for 5Q00 nonulation at the berinhery.
The entire package of sendees has b^er envisaged to be
delivered by the social welfare and the health functionaries of the
block through guidance from the respective.authoriities from district and
pta.to. The1 ■ flow-chart at the end illustrates the administrative arrange
ments. in an I(TS project'*
' • - Training _of --personnelr ~ The anganwadi workers have-been given
basic training for 3 months at anganwadj training centres and a Continued
inservice training is given by the PHO physicians on all pay days with
( emonstrations at the maternal and child health and.family welfare
planning clinics and subcentres in groups of £-10 anganwadi workers-.
Monitoring and...evaluation? The evaluation, of organisation and
implementation of the scheme has been entrusted to the P1^ Cell of the
Hanning Commission, and periodic monitoring and -valuation or health and
nutrition was undertaken bv All India Institute of Medical Sciences
through annual surveys which were conducted by th1- medicali co"lege
consultants.
A)
: 3 :
Pole of medical colleges: Ip provide technical guidance,
supportive supervision and training to various grades of -functions of
the programme, it was deemed necessary to appoint paediatricians as
consultants to projects nearest to the medical colleges. To conduct
periodic surveys for. assessing the impact of services on health and
nutrition, graduate interns were mobilised and in 15 projects it was
possible to conduct 3 surveys within 2 years.
In,the expanded pro^prammetaking the- distance of projects
I ran the medical colleges and propagative nature of work, and also easy
mobility of district staff, the paediatricians and the health officers
+ f Tr-nQOSpeC?t','Ve
headquarters were appointed as consultants to
/ e . K projects. ^Presently 54 consultants are the paediatricians or
teachers of preventive and social medicine frm medical colleges, while
35 consultants are officers from the districts.
achiw
wnt
OF I C B Si
1- lstg^2£shmerit of infrastructure; Desm'+.e the difficulties in
of- ™intments a ve’iy lar^e nronortion of health and non-health
+
staff (81% and 99% respectively) is on the ground in projects of first
phase, o which more than 88% of staff has undergone formal training-.
,2: Training of fun.ctionar.ies and supportive supervision: The •
.
asic training - of anganwadi workers, mukhya.sourikas and child development
project officer was arranged hy the National Institute of Public
anrJ
development. All the physicians placed at the
10 S project and their supervisors at the district were trained
regionally at the medical colleges by the consultants. The *.11 India
Institute of Medical Sciences introduced the in-senrice training of
anganwadi workers and the ANMs within PHC with emphasis on primary
health.cape and monitoring of maternal and child health and nutrition.
The orientation is conducted by the nhysicians at the PHC or at sub-centres.
. £2.-ordination: The Child Developmen t Project Officers and
the PHC nhysicians are the key persons in the-implementation of the
programme. The expedience at the projects shows that medical college
consultants have bean successful in introducing environment of team
approach by participating in various activities of anganwadi through
coordinated supervision, re-organisation of the services-of administration,
referrals and establishing an information system through regular data
?.0 /
services to highrisk-mothers and children were intensitied, both at village and health centre level.
^.sults__of the surveys: Three surveys were conducted in 28
.
projec s at three different points at an intenral of approximately one
year on a sarnple of 10% anganwadis, Data from 15 projects has been
compi ed, which shows that there is a nrogressivj increase in eoverage
o. population of women and children regarding thiir enrolment, supplem?ncary nutrition, antenatal and postnatal checkup, immunisation and
distribution of vitamin
and folifor tablets. Further, there is
remarkable, improvement in the nutritional status of children with almost
5-/o ieduction in Grade III and Grade ^‘malnutrition.
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SPECIAL BENEFITS OF THE ICFS PROGPJWE:
1. The blocks where an ICDS project is running have also been
selected for upgrading the PHC under the minimum needs programme. The
ICT'S nrogramrie has ensured the supply of refrigerators to these PHCs
thereby helping in the immunization programme. Sufficient amount of
medicines including folifer tablets and vitamin ’A’ have been given to
these projects with additional budget for medicine from TOTS. These
projects were given the transport at a priority basis. Rural
electrification and water supply programmes have al so been augmented
in this project areas.
2, An^nnwac1!-worker
mothers and children:
an ar/orrt of healt-h care delivery to
The anganwadi worker has be°n envisaged as a care taker for
growth and. devej.opinent of young children and education of young mothers.
Their selection from the local community and ability to render the package
of service at the anganwadi has Droved to bn an asset. The fact, that
she is the only ava..ilable and accessible health workr^r at the village
level became a compelling need to train her in living1 treatment for common
ailments at first contact. Her training in urinary health care and first
aid has been found extremely beneficial to the community and corro lamentary
to work of ANMs. The haalth care has now been included in the sv"?labus
of anganwadi workers’ basic course and continued training at the PHC and
the sub-centres aims at making tfem proficient, in treatment of Tat risk1
children and mothers.
3. Active iiivolvemont of pa.odl.atri ci an s and teachers of community
medicine has installed an academic impetus -t« the performance of health
functionaries and management of severely malnourished children. Continuous
training of various level workers has ensured Letter standards. The
participation of graduate interne in the health Surveys has proved to he
an interesting .field exercise which is hopefully expected to motivate them
in the NCH work in their future practice. The consultants from the medical
colleges have also been able to mobilise members of other disciplines in
training and surveys. Most of the medical colleges are currently
participating in this rational programme.
4* The state directorates of health services have taken special
interest in ICTS recognising the approach as an alternative strategy to
delivery of health care.
WFOT SHOTEP PE BETTER ACHTTWr- tm ICPS
1. Chaldron in age group 1-3, particularly the ones who are
suffering with severe degree of malnutrition rtill remain inadequately
covered. A system to establish nutrition therapy for such children at
home or at sub-centre and. PHC needs to be developed, though high calorie
therapeutic food has been made available for treatment of those affected.
2. The referral system from an^anwadi to the PHC and onwards
needs supnort from the administration.
3. Inspite of renewed emphasis, the nutrition and health education
activities rema,in low in service priority.
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4. The improvement in water supply and sanitation has also
not nicked at a faster pace•
CONCLUSION
The comprehensive approach of child development is well conceived
in ICDS projects and preliminary programme in 150 areas shows promising
results. The ICDS programme is an example of unified efforts of Social
Welfare and Health Departments leading to fulfilment of needs of those,
who are deprived and neglected.
Integrated Child. Development Services Scheme (1076).
Published by the Department of Social Welfare, Government of India
Printing Press,Institute for the Deaf 4^/6, Jhandewalan Extn.,
New Delhi.
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